PHARM - Drugs Affecting the Respiratory System: Asthma - Week 7

Question 1

Define athsma.

Answer 1

A heterogenous disease of chronic airway inflammation

Question 2

List 4 symptoms of athsma.

Answer 2

Wheezing
Breathlessness
Chest tightness
Cough

Question 3

What is the prognosis of athsma like?

Answer 3

Generally good with proper management and treatment compliance

Question 4

Give three host factors that influence the development of athsma.

Answer 4

Genetics
Gender (females more)
Obesity

Question 5

Name 6 possible environmental factors that can influence athsma development.

Answer 5

Indoor allergens
Outdoor allergens
Chemical irritants
Tobacco smoke
Air pollution
Respiratory infections

Question 6

Breifly explain the pathogenesis of athsma (7).

Answer 6

Allergens are taken up by APCs, which activate Th2 cells, which activate mast cells, which produce IgE.
Mast cells with IgE that bind the allergen release mediators of bronchospasm, mucus, and vascular leaks.

Question 7

Define allergic athsma.

Answer 7

Airway obstruction due to chronic eosinophilic airway inflammation.

Question 8

What happens to bronchial blood vessels with athsma and what does it result in (2)?

Answer 8

Blood vessels are leaky and dilated.

Results in airway mucosal oedema and swelling.

Question 9

What happens to mucus production with athsma? What does this result in?

Answer 9

Hypersecretion. Results in the occlusion of the airway lumen.

Question 10

Name the three key components of allergic athsma pathogenesis and whether they are well/poorly understood.

Answer 10

Induction phase - poorly understood, related to acquisition of allergy
Smooth muscle shortening - well understood
Inflammation - not completely understood

Question 11

Name one way to prevent or reverse airway obstruction in athsma.

Answer 11

Treating the smooth muscle contraction which is relatively easy.

Question 12

Describe one way to prevent or reverse airway inflammation.

Answer 12

Inflammation is partially sensitive to glucocorticoids (corticosteroids)

Question 13

Name two relaxant agents of the airway smooth muscle.

Answer 13

Adrenaline

B2 adrenoceptor agonists

Question 14

Name threeconstrictor agents of the airway smooth muscle.

Answer 14

Histamines
Leukotrienes
Acetylcholine

Question 15

What is the main mechanism of action of B2 agonists in athsma treatment?

Answer 15

Relaxes smooth muscle cells by decreasing cytoplasmic Ca2+

Question 16

Define SABAs, what kind of substance it is, what kind of treatment it is, whether it is fast or slow acting, and how long it lasts.

Answer 16

Short-acting B-adrenoceptor agonist
Is a reliever
Mainstay of acute bronchodilator therapy
Rapid action (2-5m)
Lasts 2-4h

Question 17

Name 3 adverse effects of SABAs.

Answer 17

Tremors
Palpations
Headache

Question 18

Explain drug delivery to the lungs.

Answer 18

Using an MDI, 10-20% is inhaled to the lungs and goes directly to systemic circulation.
80-90% is swallowed, and absorbed into the GI tract, going to the liver first.

Question 19

Define LABAs, what kind of treatment it is, what it must always be combined with, and an additional benefit over other treatment for athsma.

Answer 19

Long-acting B2-adrenoceptor agonists
Is a preventer
Always combined with a glucocorticoid
Has the benefit of chronic bronchodilation

Question 20

Describe briefly what happens in aspirin-induced athsma and what drug is used to treat it.

Answer 20

Overproduction of LTs

cysteinyl-leukotriene receptor antagonists are used.

Question 21

How do glucocorticoids prevent/reverse inflammation?

Answer 21

They decrease inflammatory gene expression

Question 22

Are glucocorticoids fast or slow acting?

Answer 22

Slow onset of action

Question 23

When are glucocorticoids used and how is it administered (2)?

Answer 23

Used as a first line therapy for prevention

Inhaled or taken orally

Question 24

Name four side effects of inhaled glucocorticoids.

Answer 24

Hoarseness
Weakness of voice (dysphonia)
Atrophy of vocal cords
Oral thrush

Question 25

How can the side effects of inhaled glucocorticoids be reduced?

Answer 25

Mouthwash

Question 26

What should be done with chronic use of oral glucocorticoids and to prevent what?

Answer 26

Taper dose to prevent withdrawal

Question 27

Name 4 side effects of oral glucocorticoids.

Answer 27

Hypertension
Weight gain
Diabetes
Osteoporosis